Tuesday, 16 June 2009

Developing costs to develop an equitable high quality service

The final report of the dialysis PbR group was published on 1 June to coincide with the British Renal Society Annual Meeting. I have spoken before about the importance of this project that brought finance and clinical leads from 16 Trusts together to gain a better understanding of the components and costs of dialysis. Quality is the organising principle of the NHS. Patients, clinicians, commissioners and regulators all have a role in defining quality. The quality report needs to correspond to the financial spreadsheet – the key link being the clinical codes that capture the details of care.

It seems an age ago when the project started. In October 2007, the NHS was beginning the Next Stage Review, the UK economy was still strong and the run on Northern Rock hadn’t started. Arsenal were top of the Premier League. The need for robust costs was driven by the continuing growth of dialysis and our concerns about capacity. Lean thinking was in there but the importance of productivity was not as stark as it is now that the public debt has doubled to nearly 80% of the gross domestic product.

Finance directors, clinical directors, lead nurses, commissioners and kidney patient associations should all scrutinise, not only read this report. All those involved in delivering, coding and accounting for clinical activity should take care to record accurately. Accurate recording is the basis of good clinical practice – it should not be sloppy, it should not be an afterthought.

I think we will look back and see this PbR project as the first step in bringing quality, innovation and productivity together in kidney services. The lessons learned are now being applied to kidney transplantation and to develop a best practice tariff for dialysis. Definition, accurate specification and costing of other aspects of advanced kidney disease will follow. Bev Matthews (Director, NHS Kidney Care) managed the project superbly well – it was hard but rewarding work for all concerned. To quote the authors “the project has achieved its aim and provided more transparency to the calculation of renal dialysis costs” (Chris Newton, Senior Divisional Finance Manager, University Hospital, Birmingham); “it provides more informed data for the tariff system. It also enabled clinicians and finance to learn about each others work” (John Bradley, Consultant Physician, Addenbrookes Hospital, Cambridge); “to do this type of project in other areas you need buy-in from interested clinicians and finance staff. Clinicians don’t always get involved in this type of project but it is important that they do” (Hugh Cairns, Consultant Nephrologist, Kings College Hospital, London).